HYPOTENSION, ORTHOSTATIC NMH, CARDIOGENIC SHOCK

Question 1

hypotension (NMH)
- definition
- causes

Answer 1

• systolic BP <90 and/or diastolic <60

causes:
- meds (BB, alpha block, CCB, nitrates), - hypovolemia (blood loss, excessive diuretic use, dehydration, anemia)
- low CO (MI, bradycardia, HF)

Question 2

Hypotension: symptoms

Answer 2

dizzy/lightheaded, fatigue, weakness, syncope, SOB, exertional dyspnea, CP, palpitations, headache, cough, seizures

Question 3

Orthostatic hypotension
- definition
- causes

Answer 3

• dec in systolic BP >20 or diastolic >10 from supine to sitting or standing

causes: cardiac arrhythmias, dehydration, meds (alpha blockers, diuretics, narcotics, MAOIs/rasagiline, TCAs/amitriptyline), neurogenic, endocrine d/o, anemia

Question 4

Orhthostatic hypotension: dx and tx (conservative + medications)

Answer 4

Dx: bp readings lying, sitting, standing (orthostatic measurements)

tx:
- conservative management: inc hydration, inc salt, slow positional changes, compression stockings, exercise, tx underlying cause
- meds: fludrocortisone, miodrine, droxidopa (mineral corticoids)

Question 5

Cardiogenic shock

Answer 5

cardiovasc failure due to lack or or loss of tissue perfusion

• systolic BP <90, w/urine output <20 mL/hr
• end organ tissue perfusion
• hypotension refractory/resistant to volume resuscitation

heart NOT pumping hard enough, volume resus wont correct it regardless

Question 6

Cardiogenic Shock: causes

Answer 6

• ACUTE MI (MC CAUSE)
• cardiac tamponade (cant get blood into heart/or out)
• pneumothorax
• arrhythmia
• PE
• cardiomyopathies (weak ventricle)
• HF
• cardiac contusion (airbag, kicked in chest)
• valvular and septal abnormalities

Question 7

Cardiogenic shock- clinical features

Answer 7

**hypotension, tachycardia, alt mental status, oliguria/anuria **

• cool extremities, dec capillary refill, weak periph pulses, JVD, pulm congestion/edema

Question 8

Cardiogenic shock: tx

Answer 8

FIRST STEP: ABCs (airway, breathing, circulation)
- 2 large bore needles–> central line (fluid resus) and arterial line (bp monitoring)

• Vasopressors: dopamine, dobutamine, norepi
• intra-aortic balloon pump
• tx underlying cause

Question 9

Cardiogenic shock: tx for underlying causes

Answer 9

Acute MI: aspirin, heparin, nitrates, etc.
- emergent revascularization (coronary angiogram)

Cardiac tamponade: percardiocentesis, pericardial window

Arrhythmias: ACLS protocol

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